Wiki Billing Influenza

[lisa dixon]

I would like to see how others are filing influenza to Medicare and private insurance.

Example: Patient comes in as flu shot only (90658,G0009).

How do you file Medicare patient in office for other exam (99214, 401.9,428.0, 493) at the visit the provider decides to give a flu vaccine, and also for a commercial insurance.

I have heard to charge 90471 to commercial for administration even if patient is seen and to add modifier 25 to Medicare claims with the appropriate V code.

At the same time I have heard not to bill 90471 or modifier 25.

Thanks in advance for your replys.

 

[nishwitzp]

flu vaccine

medicare with no visit: 90658 or 90662(for new High dose vaccine) and G0008
G0009 is for administration of Pneumonia vaccine

medicare with a OV use the 25 modifier on the E & M code with diagnosis for the visit
and flu shot same as above with the ICD-9, V04.81, code on flu vaccine codes

for commercial product no office visit
use the CPT code that matches the vaccine you are using
90655 - 90662 and immunization administration code 90471

for commercial product with office visit
may need to ck with insurance company
but I usually do the OV with 25 modifier with appropiate diagnosis linked to it
and flu shot (again cpt that matches the vaccine you are using) and the administration code 90471 or use the with counseling administration code if indicated.
I have heard that you can use a SK modifier on the flu vaccine (not the administration code)if the pt is a High risk (ie asthmatic) for commercial products